Functional status after colon cancer surgery in elderly nursing home residents.
Functional status after colon cancer surgery in elderly nursing home residents.
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DOI：
10.1111/j.1532-5415.2012.03915.x
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发表时间：
2012-05
影响因子：
6.3
通讯作者：
Dudley RA
中科院分区：
文献类型：
--
作者：
Finlayson E;Zhao S;Boscardin WJ;Fries BE;Landefeld CS;Dudley RA
确定老年疗养院居民结肠癌手术后的功能状态和死亡率。回顾性队列研究。1999年至2005年间，美国6822名65岁及以上的疗养院居民接受了结肠癌手术。使用最小数据集-日常生活活动（MDS-ADL）汇总量表评估手术前后功能状态的变化，该量表为28分量表，评分随功能依赖性增加而增加。使用医疗保险住院患者档案和疗养院最小数据集，我们确定了6822名65岁及以上接受结肠癌手术的疗养院居民。我们使用回归技术来确定与术后1年死亡率和功能下降相关的患者特征。平均而言，接受结肠切除术的居民在一年内的MDS-ADL评分恶化了3.9分。术后1年，死亡率和持续功能下降率分别为53%和24%。在多变量分析中，年龄越大（年龄80岁以上v.65 -69岁，调整后相对危险度（ARR1.53），95%CI 1.15-2.04，p<0.001），手术住院后再入院（ARR 1.15），95%CI 1.03-1.29，p<0.01），手术并发症（ARR 1.11，95%CI 1.02-1.21，p<0.02）和术前功能下降（ARR 1.21，95%CI 1.11-1.32，p<0.0001）与1年时的功能下降相关。疗养院居民结肠癌手术后死亡率和持续的功能下降是非常常见的。需要在这一弱势群体中采取旨在改善手术结果的举措。
To determine functional status and mortality rates after colon cancer surgery in older nursing home residents. Retrospective cohort study. 6822 nursing home residents age 65 and older who underwent surgery for colon cancer in the United States between 1999 and 2005. Changes in functional status were assessed before and after surgery using the Minimum Data Set-Activities of Daily Living (MDS-ADL) summary scale, a 28-point scale in which score increases as functional dependence increases. Using the Medicare Inpatient File and the Minimum Data Set for Nursing Homes, we identified the 6822 nursing home residents age 65 and older who underwent surgery for colon cancer. We used regression techniques to identify patient characteristics associated with mortality and functional decline at 1 year after surgery. On average, residents who underwent colectomy experienced a 3.9 point worsening in MDS-ADL score at one year. One year after surgery, the rates of mortality and sustained functional decline were 53% and 24%, respectively. In multivariate analysis, older age (age 80+ v. age 65–69, adjusted relative risk (ARR 1.53), 95%CI 1.15–2.04, p<0.001), readmission after surgical hospitalization (ARR 1.15), 95%CI 1.03–1.29, p<0.01), surgical complications (ARR 1.11), 95%CI 1.02–1.21, p<0.02), and functional decline before surgery (ARR 1.21, 95%CI 1.11–1.32, p<0.0001) were associated with functional decline at one year. Mortality and sustained functional decline are very common after colon cancer surgery in nursing home residents. Initiatives aimed at improving surgical outcomes are needed in this vulnerable population.
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DOI：
10.1111/j.1532-5415.2005.53216.x
发表时间：
2005-04-01
影响因子：
6.3
作者：
van Dijk, PTM;Mehr, DR;Ribbe, MW
通讯作者：
Ribbe, MW
影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
影响因子：
10.3
作者：
Bradley, Cathy J.;Clement, Jan P.;Lin, Chunchieh
通讯作者：
Lin, Chunchieh
影响因子：
3
作者：
Li, Yue;Cai, Xueya;Glance, Laurent G.
通讯作者：
Glance, Laurent G.
DOI：
10.1111/j.1532-5415.2008.02023.x
发表时间：
2008-12-01
影响因子：
6.3
作者：
Boyd, Cynthia M.;Landefeld, C. Seth;Covinsky, Kenneth E.
通讯作者：
Covinsky, Kenneth E.